Group Membership Form

For groups whose main purpose is cultural or multicultural

Name of Group*
Group's Representative*
First Last
Position / Job Title*
Phone*
Address*
Street Address Address Line 2 City/Suburb State/Territory Post code
Email*
Are you renewing your membership or are you a new member?*
Briefly describe your group’s purpose or activities:*
Member Statement*
- My group agrees to support multiculturalism and abide by the rules of the association
Group membership Fee*
Price: $ 5.00
Would you also like to make a donation?*
- Yes please
- No thanks
Donation amount:
Total
$ 0.00
I would like to pay by:*
- Credit card
- PayPal
Credit Card

MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name